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In the course of a comprehensive, tour de force of a speech by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who opened for the Opposition, the concern was also raised that the legislation incentivises care homes to re-brand as extra care. The hon. Member for South Thanet picked up that point, too, although, in an otherwise very fair-minded speech, he did not seem to grasp the argument that the Opposition have cogently made. Given how the Bill might operate, there is no indication that a care home will have to do anything more than bill its residents separately for accommodation on the one hand and care on the other to qualify, under the terms of the Bill, as an establishment that does not provide accommodation together with care. That could bring the whole 500,000-person strong, £1.2 billion cost of residential care within the ambit of the scheme.
There are questions about reablement, a word that my hon. Friend the Member for Beckenham (Mrs. Lait) found difficult to deal with. Let us call it occupational therapy, if she prefers. Will it be available to those with palliative care needs who can live for many years? Why have the Government assumed that one quarter of people will not be processed-a worrying enough word in itself-each year? Will the Bill's stipulation that reablement must come before free care create a perverse incentive to councils to delay reablement work? That is another key area, and it clearly needs deep Committee scrutiny if we are to get to the bottom of it.
There is little joy for carers in the Bill, as the assessments will not be carer-blind. The Government have put ever-increasing pressure on carers, and the Bill is likely to exacerbate that. My hon. Friend the Member for Braintree (Mr. Newmark) echoed that concern in his interventions on value and, even, non-financial value-something about which the Secretary of State was concerned when he was a Minister.
The Secretary of State has also spread confusion about the NHS "taking over" social care. Despite the pre-briefing, nothing new was announced, but now councils think that they are about to be shot of the problem. Furthermore, the narrow focus on care rather than support might mean that people who could stay in their homes will be driven into residential care. That is the very mischief that the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) persistently, wrongly and, I am sure, without any party political slant at all seeks to portray as the problem, as he perceives it, with our very well-received home protection scheme. Scope says:
"By overlooking the needs of deafblind people to communication support, the government is in effect excluding a group of people who are most at risk of having to enter residential accommodation."
Another area with which the Government are, frankly, playing fast and loose is the finances of the scheme, a point clearly and compassionately made by my hon. Friend the Member for Beckenham on behalf of her constituents. They include my elderly parents-in-law, who are in receipt of the very good services in Bromley and, let it be said, vitally, the attendance allowance that helps them to stay in their own home-with all the benefits that that brings.
The impact assessment provides costing only for two and a quarter years. I have never read an impact assessment that has not costed a policy for at least 10 years. The period of two and a quarter years brings us to a certain
magical part of the calendar and is clearly another part of the impact assessment's panic drafting. The Government's own Green Paper looked to 2050, and, in this vital area, that is the span that we all know we must consider.
The impact assessment confesses that there is "inherent uncertainty" in estimating the costs. I asked the Government, through parliamentary questions, to extrapolate the amount, even using contemporary assumptions, but they repeatedly refused. Doing it myself, therefore, I found that the policy will cost at least £1.2 billion a year by 2030. If their assumptions are wrong by just 1 per cent., and that is almost guaranteed with this Government, that will add about £40 million to a £650 million cost in the first year.
The Local Government Association is particularly concerned that the Government have "underestimated". If the Government are serious about this policy being part of the reform of the system, they must bring forward the proper costings, as my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes) said in a wide-ranging, exemplary and significant contribution that had his constituents' interests at heart throughout.
During the general debate on health and social care reform on 29 October, in response to some pressure from Members on the Government Benches, the Secretary of State ruled out funding from general taxation because it would not
"be fair across the generations to ask the working-age population to pay for the costs of care"
"it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation."-[ Official Report, 29 October 2009; Vol. 498, c. 479-81.]
Those reasons were also cited in the Green Paper. He therefore needs to explain why it is "honest" or "fair" to do that through this policy but not the whole reform, and how a policy clearly at odds with the principle of the Green Paper can be said to be in its direction of travel-a point ably highlighted in a comprehensive speech by my hon. Friend the Member for Norwich, North (Chloe Smith). It was precisely this tension that led my hon. Friend the Member for Poole (Mr. Syms), in a clear and caring speech that focused on his constituents' needs, to argue so powerfully for the detailed and adequate scrutiny of the Bill-that is, in a proper Committee stage instead of one day on the Floor of the House.
Furthermore, Ministers have not yet come clean on exactly which budgets they are slashing to pay for this measure. Some £250 million, which was spun as a real-terms cut in the pre-Budget report, is set to come from as yet unrealised local government "efficiency savings"; in other words, they are going to spend it on this instead. Many organisations, including the Learning Disability Coalition, Age UK and Sue Ryder Care, have pointed out that this
"could mean cuts for other people with care needs".
"It is difficult to see how local government could meet the cost of this proposal from current plans for efficiency savings, without the lifting of other burdens."
When pressed through parliamentary questions, Ministers have given the reply, devoid of hope for these organisations, that setting charges for social care is a matter for local authorities. We know that the Government are also taking it out of research budgets but have not yet identified which ones, generating great concern particularly among cancer charities and-as highlighted by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), whose speech was, as always so focused given the information and expertise that he has in chairing the all-party group on dementia-among dementia charities, to whom the Minister of State only recently pledged more funding. The Government are also taking it out of the NHS IT budget, which funds a programme that, according to Ministers, was all about patient safety, patient care and a more efficient use of public money-until last weekend, when it became, to quote the Chancellor,
"frankly...not essential for the front line".
It is important that Ministers clarify exactly where the money is coming from. The House will see that this scrabbling together of money from different pots shows that the Government seem to have no idea of how to fund this measure in the long term.
On the positive side, one of the exciting additions to the Bill could be legislation to underpin our home protection scheme. This would enable every 65-year-old to buy into a risk pool at the cost of £8,000 or so, insuring them against the catastrophic costs of admission to residential care. It delivers on Tony Blair's promise in 1997 to stop people having to sell their homes to pay for their long-term care; last year, 45,000 people had to do just that. These people probably did not grow up with parents who owned property but have been enabled to get on to the property ladder, many in the 1980s, and who could have given their children and grandchildren a start in life that they themselves could never have dreamed of. Instead, once again, the Government have got rid of a driver of social mobility. Of course, the policy will be attractive only to those who would otherwise fail the means test; it is right that those with assets under £23,000 should continue to be supported by the taxpayer.
This is not the time for a litany of failure on social care-the point is made by the gap between Tony Blair's 1997 pledge and this Bill, which shows only the first glimmer of full-scale reform. So much for the demand made, not least by Conservative Members, that truth be given to the aspiration allegedly contained in the Green Paper. In the last general debate, the Secretary of State spoke of his desire to create "unstoppable momentum" for reform. It is a somewhat plaintive cry as he positions himself, I would argue, for the future and his campaign for the Labour leadership. We wish him well; he would be a great asset to us. If he truly wants to create that momentum, he will work with us, not against us. Despite his confession to me, some months ago, that he is tribal at heart, I hope that he can none the less see a way to working with us. A beginning would be to give the Bill due time in Committee, not just a day on the Floor of the House. Of course we must and will divide the House to oppose the programme motion, while not opposing Second Reading. As I have said and as my hon. Friend the Member for South Cambridgeshire said in his opening speech, the Bill contains some worthwhile provisions but should be set in an overall architecture, rather than the Government taking this spatchcock approach to legislation.
My favourite part of the regulatory impact assessment is paragraph 5.29, which notes the risk that
"current research and evidence available does not accurately estimate the true numbers who may come forth to seek assessment and services."
The archaism "come forth" suggests a draftsman who sees the policy for what it is, but it also gives us some ground for optimism-those are, after all, the words that brought Lazarus from the grave. I hope that if Ministers are willing, we can resurrect social care reform across the whole spectrum of care in this Parliament rather than be forced to wait for the next, when the House can be assured that if given the chance, we will act.
9.45 pm
The Minister of State, Department of Health (Phil Hope): The question of how we create a fairer, more affordable system of care and support is one of the defining issues of our day. From my visits to people being looked after in their own homes and my meetings with carers, I know how much it matters to individuals, families and communities. It is a subject that deserves serious, non-partisan discussion in the House. We have had many contributions worthy of it, and I welcome the forewarning that the hon. Member for South Cambridgeshire (Mr. Lansley) gave me before the Committee stage in the new year, with his detailed questions about the impact assessment. I look forward to debating them further in due course.
Apart from the final contribution by the hon. Member for Eddisbury (Mr. O'Brien), we have had a welcome absence of scaremongering or political point scoring. At the start of the debate, my right hon. Friend the Secretary of State laid out the challenge ahead and explained how the changes to our society in demography, life expectancy and better medical treatment spell out the need for decisive action on social care.
We know the salient facts. This is a country with more pensioners than people under the age of 16. The Office for National Statistics suggests that by 2033 the number of people aged over 85 will rise from 1.3 million to 3.3 million and the ratio of working-age adults to pensioners-the so-called dependency ratio-will drop below three. By 2050, it will fall to the point at which there will be only two working adults for every pensioner. The facts speak volumes about the need for bold and far-reaching reform. The message is stark: without radical action, our ability to meet the needs of our ageing population will decrease, and the unfairness that we already see across the care system will mount year on year.
I thank my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), who said that there had been a transformation in social care over the past few years. That was in stark contrast to the views of the hon. Member for South Cambridgeshire, who opened his remarks by criticising the lack of action. He neglected to tell the House about the 50 per cent. real-terms spending increase on adult social services since 1997, or the £500 million grant given to councils in the past three years to help personalise social care services and pursue the personalisation agenda that many Opposition Members reminded us about. He neglected to mention our efforts through the national dementia strategy, which I had the privilege of launching earlier this year, or the ministerial
research group that I launched following the national summit to ensure that more resources go into researching the causes of and cures for dementia and the care of people with it.
The hon. Gentleman did not mention the work under way through the carers strategy to support the friends and families who make such an important contribution to our society, the existence of 11,000 dignity champions throughout our health and social care system, or the fact that the Care Quality Commission report on care and council performance published earlier this month showed that 80 per cent. of homes and agencies and 95 per cent. of councils were rated as "good" or "excellent". Opposition Front Benchers completely ignored and overlooked all that progress.
Despite the progress, we know that the structural changes in our society call for wholesale reform of our care system. That is why our proposal to create a national care service, which many Opposition Members have lauded and applauded so much this evening, is so important. I am delighted that so many hon. Members have now seen the light and are following Labour's lead in forming a National Care Service for the future, which will be fairer, simpler and more affordable, underpinned by national rights and clear entitlements, driven by quality and built around the individual's needs.
Many hon. Members discussed the importance of improving quality. Let me remind the House of what we are doing on raising skills in the work force-another issue that has been debated this evening. For example, we have created a National Skills Academy for Social Care, driving forward training, development and career progression for the adult social care work force. Our social work taskforce sets out how we further support the social work profession. We are doing more to attract young people into the care work force, not least under our "Care First" career scheme, which was launched earlier this year, and by creating an extra 1,000 apprenticeships opportunities.
We are also ensuring that a clear and wide range of interventions are available. The hon. Member for South Cambridgeshire was highly critical, but he forgot about "Putting People First" and the £60 million we made available to local authorities to encourage investment in telecare and supportive mechanisms to help people in their own homes. Our recent publication on the use of resources further promotes the use of such early interventions and preventive responses. Therefore, to suggest that there has not been a period of investment, reform and change over the past 10 years is to deny and ignore completely what has happened; and frankly, it will leave those who have done so much work on the ground feeling that the Conservatives do not know or care about their work.
The Bill is part of that journey and an important bridge to a National Care Service. Let me set out clearly what it stands for. First and foremost, it represents action now for 280,000 people with the highest level of need-those with advance dementia and Parkinson's disease. It will remove the unfair burden of cost on those people and their families. My hon. Friend the Member for Crawley (Laura Moffatt) made a heartfelt plea, based not least on her experience of working with people with dementia, for more help now to prevent the unnecessary admission of people with advanced dementia to hospital. [ Interruption. ] I share her concern about
that, yet for five hours, Tory Members have found reason after reason for not going ahead with the Bill. We have heard them say, "It's only a part of the jigsaw, so do nothing"- [ Interruption. ]
Mr. Speaker: May I just interrupt the Minister of State for a moment? There are a lot of private conversations taking place on both sides of the Chamber, including on the Government Front Bench. The consequence is that the oration of the Minister of State is not receiving the close attention that he will think it deserves.
Phil Hope: Thank you, Mr. Speaker.
The Conservatives said that it is only a part of the jigsaw, so do nothing-those were the words of the hon. Member for Norwich, North (Chloe Smith). They say, "It is political posturing in front of an election, so do nothing. We need a bigger reform, so don't do this one. It will cost too much given our cuts policies for the next few years, so do nothing." We understand the Conservative position on the Bill: it is to do nothing for someone requiring 17 hours of personal care a week or intimate care, including help with eating, drinking, washing, dressing and toileting, who could be paying about £13,000 a year out of their savings. They would not get any help with that because the Tory party would do nothing.
Mr. Lansley: I am grateful to the Minister for giving way in the midst of the non-partisan discussion he said he was going to have this evening, but when is he actually going to reply to the debate? For example, the hon. Member for South Thanet (Dr. Ladyman) talked about advanced dementia. I was in a dementia ward last week- [ Interruption. ] That is not very funny. I was in a dementia ward last week and was told of a patient who had been discharged home to die and did not have access to NHS continuing care. The hon. Gentleman made a valid point. When there is serious advanced dementia, why is NHS continuing care not meeting that need, rather than having someone depend on personal care under the Bill?
Phil Hope: We have not got the time to get into the details of what happens if somebody has continuing needs with dementia. They have both health needs and care needs. The point that the hon. Gentleman has made about the Bill is clear-those on the Tory Benches would do nothing. They suggest that we would not provide the care at home in cases of advanced dementia that we all know is needed.
Phil Hope: I am not going to give way, because I want to address the point made by the hon. Member for South Cambridgeshire and answer some of the other points that he and his hon. Friends made in saying that under the Bill, such care would be free.
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